Neck of Femur Fracture Flashcards
What is the mortality rate following a neck of femur (NOF) fracture?
The mortality of a femoral neck fracture up to 30% at one year.
What are the common mechanisms of NOF fractures?
Neck of femur fractures are typically caused either by low energy injuries (the most common type), such as a fall in frail older patient, or high energy injuries, such as a road traffic collision or fall from height and are often associated with other significant injuries.
Briefly describe the blood supply to the NOF
The blood supply to the neck of the femur is retrograde*, passing from distal to proximal along the femoral neck to the femoral head. This is predominantly through the medial circumflex femoral artery, which lies directly on the intra-capsular femoral neck.
What is the risk of displaced intra-capsular NOF fractures?
Displaced intra-capsular fractures disrupt the blood supply to the femoral head and, therefore, the femoral head will undergo avascular necrosis (even if the hip is fixed). Patients with a displaced intra-capsular fracture therefore require joint replacement (arthroplasty), rather than fixation.
Briefly describe The Garden Classification for Intracapsular Hip Fracture
What are the symptoms of NOF fracture?
The leading symptom is trauma, often low-energy, which is followed by pain and an inability to weight bear. Pain is felt predominantly in the groin, thigh or, commonly in the elderly, referred to the knee.
How does the leg appear following a NOF fracture?
On examination, the leg is characteristically shortened and externally rotated, due to the pull of the short external rotators, with pain on pin-rolling the leg and axial loading.
What investigations should be ordered for NOF fracture?
Initial plain-film radiographic imaging should include antero-posterior (AP) and lateral views of the affected hip, as well as an AP pelvis. Obtain full length femoral radiographs too, if there is suspicion of a pathological fracture.
Basic routine blood tests, including FBC, U&Es, and coagulation screen, are required alongside a Group and Save; if a long lie time could have occurred, a creatinine kinase (CK) level would be recommended to assess for any significant rhabdomyolysis.
A urine dip, chest radiograph (CXR) and ECG are all useful in complete assessment of the older patient group, especially for pre-operative assessment and peri-operative management.
Why is creatinine kinase important to assess following NOF fracture?
Asess for any rhabdomyolysis.
Briefly describe the initial management of NOF
Initial management of a neck of femur fracture should consist of an A to E approach to stabilise the patient and treat any immediately life- or limb- threatening problems, as this cohort of patients will likely sustain concurrent injuries (even in low-impact cases).
Ensure adequate analgesia is provided, as hip fractures are very painful. This can be either as opioid analgesia and/ or regional analgesia (such as a fascia-iliaca block).
When is non-operative conservative management used in NOF?
Non-operative conservative management is rarely recommended, as the benefits of surgical intervention nearly always outweigh the potential conservative management.
What is the surgical management of a displaced subcapital NOF?
What is the surgical management of a inter-trochanteric and basocervical NOF?
What is the surgical management of non-displaced intra-capsular NOF?
What is the surgical management of sub-trochanteric NOF?
What is shown in image A?
Pelvic radiograph showing (A) R intracapsular hip fracture.
What is shown in image B?
Pelvic radiograph showing (B) L extracapsular hip fracture.
Briefly describe the anatomy of the NOF
What is shown in the image?
What type of NOF is this indicated in?
Hip hemiarthroplasty.
Indicated in displaced subcapital.
What is shown in the image?
What type of NOF is this indicated in?
Dynamic hip screw.
Indicated in inter-trochanteric and basocervical.
What is shown in the image?
What type of NOF is this indicated in?
Cannulated hip screws.
Indicated in non-displaced intra-capsular.
What is shown in the image?
What type of NOF is this indicated in?
Intramedullary femoral nail.
Indicated in sub-trochanteric.
What is shown in the image?
What type of NOF is this indicated in?
Total hip replacement.
Indicated in displaced intra-capsular fractures in normally well and active elderly patients with high performance status can be treated with Total Hip Replacement.
Review the following NOF surgical interventions
